Health-e (Cape Town)
Olive Shisana
30 June 2009
(Page 2 of 2)
Inequalities in access are also reflected in differentials in health outcomes as the poor account for the largest share of the disease burden. Key health outcomes such as infant, child and maternal mortality are on the rise: most of these avoidable. The country is way behind achieving the Millennium Development Goals and targets in this regard. These health system challenges call for innovative mechanisms for ensuring that the health care system is configured and financed in such a way that the noble objective of universal access is achieved.
What is a NHI system and it's objectives?
A National Health Insurance is a system of mandatory health insurance contributions, in which those who can afford contribute according to their ability and those who cannot afford are paid for through subsidies from government. The funds are pooled into one fund from which resources are drawn as people use services according to their need.
National Health Insurance systems address the problem of a fragmented health care system by integrating private and public sector activities using a financing instrument to achieve goals that serve the public at large.
Through larger risk pooling it is possible to facilitate fair allocation of resources including human resources, facilities and other essential services across the country. What is key here is achieving fairness of financing and risk protection for all. Those without medical aid and without financial resources face catastrophic health care expenses particularly in this economic crisis.
It is not uncommon for those who have private health insurance to exhaust their benefits early, and resort to the public sector unless they are willing and able to co-pay for services. NHI systems around the world seek to ensure that the resource pool is large enough to avoid any form of co-payments unless something is medically unnecessary. As a society we need to act in unity to achieve universal financial risk protection; more so now when the economic climate requires that individuals and companies begin to contribute to a nation-building process. The need to create a cohesive society that cares for everyone regardless of colour, class, religion, creed, ethnic group or any other division is a national imperative.
Concerns have been raised about the status of the public health system. It is true that the public sector has been facing major challenges in terms of both the quantity and quality of services it provides. Clearly, that cannot be explained by under-funding alone but by other health systems constraints such as shortages of human resources, management capacity constraints, sometimes cumbersome procurement processes and the ever increasing disease burden. Listening to the Minister of Health, Dr. Aaron Motsoaledi speak in Parliament, we should all feel assured that this is high on his agenda.
The private health sector also has its challenges. Cost escalations remain a huge challenge despite attempts to regulate the medical schemes industry. Some of the cost drivers are known: high non-health related expenditures (administration fees, managed health care fees, brokerage fees, commercial reinsurance) which in FY 2007/8 amounted to R8.9 billion. Furthermore, high specialist costs, low bed occupancies and excess capacity in the private sector, medicines (notwithstanding recent decreases) and over use (moral hazard) remain as challenges.
This debate should not be about whether or not to introduce NHI, but about what form it takes. The debate on form must take into account the challenges that are currently being faced in both the public and the private sector and if history is anything to go by the trajectory of introducing NHI through social insurance arrangements has not yielded the intended results.
These challenges of access cannot be achieved by a business as usual attitude but by fundamentally addressing the structural problems in the health care system. Such reforms will always have losers and winners but what is important is the overall gain for the public at large. We are in the most crucial period of our history, and we stand a better chance of seizing the opportunity to ensure that we realise a publicly funded, but publicly and privately delivered health care system for all South Africans.
Shisana is CEO of the Human Sciences Research Council and chair of the ANC NHI task team. She writes this in her personal capacity.
Be the first to Write a Comment!
Copyright © 2009 Health-e. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
